UNC researcher: Racial disparities in HIV infection rate are ‘indictment’ of U.S. response to epidemic

Tuesday, October 6, 2009 — UNC's Dr. Adaora A. Adimora and her fellow researchers examine factors responsible for the stark racial disparities in HIV infection in the U.S. and the now concentrated epidemic among African Americans.

Continuing racial disparities in the HIV infection rate are an “indictment” of the U.S. response to the epidemic, a University of North Carolina at Chapel Hill researcher writes in a newly published article.

Lead author of the article in the November 2009 issue of the American Journal of Preventive Medicine is Adaora A. Adimora, M.D., M.P.H., professor of infectious diseases in the UNC School of Medicine. Co-authors of the article are Victor J. Schoenbach, Ph.D., associate professor in the UNC Gillings School of Public Health, and Michelle A. Floris-Moore, M.D., clinical assistant professor in the School of Medicine.

“Continuing racial disparities in HIV infection more than 2 decades after the identification of the virus and availability of an accurate test are an indictment of the U.S. response to the epidemic,” Adimora wrote. “Existing interventions have failed to control the epidemic in African Americans in part because critical features of the socioeconomic context promote behaviors that transmit HIV and increase the risk of HIV infection even among those who do not have high-risk behaviors.”

In the article, Adimora and her fellow researchers examine factors responsible for the stark racial disparities in HIV infection in the U.S. and the now concentrated epidemic among African Americans. HIV prevalence among African Americans is ten times greater than the prevalence among whites. This racial disparity in HIV prevalence has persisted in the face of both governmental and private actions, involving many billions of dollars, to combat HIV.

The Centers for Disease Control and Prevention (CDC) estimates that 45 percent of new HIV infections in the U.S. in 2006 occurred among non-Hispanic blacks. Among the 13,184 adolescents and young adults in The National Longitudinal Study of Adolescent Health, a nationally representative study, HIV seroprevalence was almost 0.5 percent among blacks – 20 times that of whites.

While individual-level sexual behaviors can contribute to the disparity in HIV prevalence, these observed differences in individual behaviors do not fully explain the marked racial differences in HIV infection prevalence. Even when comparisons are stratified by education, poverty index, marital status, age at first sexual intercourse, lifetime number of sex partners, history of male homosexual activity, illicit drug use, injection drug use, and HSV-2 antibody positivity, HIV prevalence among African Americans exceeds that of whites, typically substantially.

According to the authors, the overall impact of these factors constitutes “structural violence,” a social system characterized by inequalities in power and life…of sufficient magnitude to restrict a group of people from realizing their full potential and put them “in harm’s way.”

“There is a need for research and interventions that are informed by expertise in public health, medicine, basic science, and social sciences – along with expertise in economics, business and finance, education, criminal justice, political science, and other disciplines … Governments should be held accountable for progress or lack thereof in eliminating inequities,” Adimora stated.